Storing Data within Health IT Systems

Kyle S. Murphy, Senior Editor EHRintelligence.com
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Health information exchange is both a network enabling the exchange of health information and the act of exchanging patient data. Much of the this focus to date has centered on the various HIEs springing up across the country — indeed Massachusetts is set to run its first tests for its exchange today — as well as the development of the Nationwide Health Information Network (NHIN or NwHIN). Despite their importance to enabling exchange, these networks are secondary to work of healthcare providers and organizations to ensure that their own systems are capable of sharing protected health information (PHI) in the first place.
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For the past four decades, the Emergency Care Research Institute (ECRI), a nonprofit organization, has helped improve healthcare through applied research of medical procedures, processes, and devices to identify best practices. In this installment of HIE Best Practices, Vice President of Applied Solutions Tom Skorup, MBA, and Senior Project Engineer Erin Sparnon offer insight based on their experiences working with healthcare systems to improve the exchange of health information, which begins with preparation within an organization’s own walls before extending to external systems and health information networks.
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Recognize the problem of exchange locally
For large health systems using a variety of health information technology, HIE is first and foremost about connecting providers within its own walls. That itself proves challenging. “Over time hospitals are moving more towards trying to find the one vendor who can supply all needs. That process is slow and painful,” explains Sparnon, “Until hospitals are able to make information available within their own walls, it may not be their first priority to be able to transmit or receive information from outside the building.”
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Get your priorities in order
Providers already have a lot of their plates. And in the coming years, they have to contend with federal mandates and initiatives regarding their use of electronic health records (EHRs) and code sets from the International Classification of Diseases, 10th Revision (ICD-10). HIE represents yet another priority, which as Sparnon observes comprises its own share of priorities:
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More and more hospitals are either buying up or affiliating with primary care offices, ancillary clinics, and other care settings, so priority one is getting data properly classified and taken care of within their own walls. Priority number two is being able to exchange information with those ancillary settings that they already have agreements with or either own or have another type of agreement with. Number three is going to be trying to support information exchange with facilities they may not necessarily have.

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To succeed in HIE, an organization must remain aware of and prepare for not only current but also future priorities at the same time. As Skorup advises, “If you’re trying to do steps one and two ­— getting your house in order — also be thinking about step three because you may have to go back and do the same work all over again.”
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Identify legacy or hard-to-crack systems
At this juncture of health IT, many of the larger hospitals use systems that were never designed for HIE. Getting at this information, especially in legacy systems, will require some re-jiggering (e.g., the addition of add-ons) to support the export of patient data. “We will still see a legacy problem for quite a while,” explains Sparnon, who has extensive experience identifying legacy challenges for medical devices. “A parallel that we see in medical devices is there’s quite a market for third-party integrators for work being done at the hospital level to essentially retrofit older systems and older devices to be more interoperable.”
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Consider obstacles to, types of interoperability
Interoperability is about more than aligning fields. It’s also a matter of semantic interoperability; that is, the systems speak the same language and share a similar understanding of relationships. As Skorup notes, mapping is key to make systems interoperate:
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There are different layers of semantic interoperability. You can have interoperability where you can see both pop up on the screen together, but there’s not a correlation between them. Then there’s getting to the point where there’s an ability to map that the data source coming in from one system is the same as another system — that you can now combine those data points and run analytics on them.

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And to ensure that data have integrity, organizations need to keep an eye on how these sets of information move between systems. “In order to get good data to be exchange internally and also to be brought into data warehouse, there has to be a level of validation that the data is consistent coming from dissimilar sources,” argues Skorup.
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Interoperability becomes more of a challenge if a provider has heavily customized their EHR or health IT systems. While it benefits the local users, customization jeopardizes reliable HIE between both providers in entirely different care settings and areas within a single organization and providers, says Skorup.
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For data to be meaningful going forward with meaningful use and new models for care delivery (e.g., accountable care organizations), they must retain their integrity when exchange between providers and organizations. Preparing for HIE truly starts with an understanding and appreciation of how electronic information is stored within health IT systems. When data have a proper structure and an agreed-upon form for exchange, only then can real HIE begin.
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Kyle S. Murphy is the Senior Editor for EHRintelligence.com. This article was first published on October 16, 2012.